Korean J Women Health Nurs.  2022 Jun;28(2):134-144. 10.4069/kjwhn.2022.05.24.1.

Nurses’ attitudes and stress related to perinatal bereavement care in Korea: a cross-sectional survey

• Kim E
• Kim HW

• KMID: 2535430
• DOI: http://doi.org/10.4069/kjwhn.2022.05.24.1

Abstract

Purpose
A descriptive correlational survey was conducted to examine nurses’ attitudes and stress related to perinatal bereavement care (PBC) and their relationships, with the ultimate goal of improving nurses’ capabilities related to PBC.
Methods
In total, 136 Korean nurses who had experienced perinatal death at least once participated. Data were analyzed using descriptive statistics. The Korean version of Nurses’ Attitudes towards Perinatal Bereavement Support was assessed in terms of three subdomains (attitudes to PBC, importance of policies related to PBC, and importance of training related to PBC), and nurses’ stress was measured.
Results
The participants gave high scores for the attitude-related items of “giving sufficient time to bereaved parents to mourn for their dead baby” (4.54 points) and “nurses should treat bereaved parents with respect and dignity” (4.51 points), and they perceived a high level of importance for the policy-related items of “every staff member in the hospital should understand the policies relevant for PBC” and “when nurses feel emotional exhaustion, they should seek support” (4.58 points). Nurses’ attitude toward PBC was associated with the perceived importance of policies (r=.40, p<.001), the perceived importance of PBC-related training (r=.61, p<.001), and stress related to PBC (r=.29, p<.001). Nurses’ perceived importance of PBC-related training was associated with stress related to PBC (r=.38, p<.001).
Conclusion
Establishing hospital policies related to PBC and providing PBC training for nurses could positively affect nurses’ attitudes toward PBC. A stress management program for nurses could reduce the stress caused by PBC.

Keyword

Attitude; Bereavement; Perinatal death

Reference

1. Cho JH, Choi SK, Chung SH, Choi YS, Bae CW. Changes in neonatal and perinatal vital statistics during last 5 decades in Republic of Korea: compared with OECD nations. Neonatal Med. 2013; 20(4):402–412. https://doi.org/10.5385/nm.2013.20.4.402.

2. Statistics Korea. Infant, maternal and perinatal mortality statistics [Internet]. Seoul: Author;2019. [cited 2020 July 16]. Available from: http://kosis.kr/upsHtml/online/downSrvcFile.do?PUBCODE=YJ&FILE_NAME=/YJ/0801.hwp&SEQ=23.

3. Barfield WD; Committee on Fetus and Newborn. Standard terminology for fetal, infant, and perinatal deaths. Pediatrics. 2016; 137(5):e20160551. https://doi.org/10.1542/peds.2016-0551.

4. Camacho D, Pérez Nieto MA, Gordillo F. Guilt and bereavement: effect of the cause of death, and measuring instruments. Illn Crisis Loss. 2020; 28(1):3–17. https://doi.org/10.1177/1054137316686688.

5. Moon Fai C, Gordon Arthur D. Nurses' attitudes towards perinatal bereavement care. J Adv Nurs. 2009; 65(12):2532–2541. https://doi.org/10.1111/j.1365-2648.2009.05141.x.

6. Health Service Executive. National standards for bereavement care following pregnancy loss and perinatal death [Internet]. Dublin, Ireland: Author;2016. [Cited 2022 Mar 10]. Available from: https://rcpi-live-cdn.s3.amazonaws.com/wp-content/uploads/2018/06/Perinatal-Bereavement-Standards-Report.pdf.

7. Boyle FM, Horey D, Middleton PF, Flenady V. Clinical practice guidelines for perinatal bereavement care - an overview. Women Birth. 2020; 33(2):107–110. https://doi.org/10.1016/j.wombi.2019.01.008.

8. Aiyelaagbe E, Scott RE, Holmes V, Lane E, Heazell AE. Assessing the quality of bereavement care after perinatal death: development and piloting of a questionnaire to assess parents’ experiences. J Obstet Gynaecol. 2017; 37(7):931–936. https://doi.org/10.1080/01443615.2017.1316710.

9. Chan MF, Chan SH, Day MC. Nurses’ attitudes towards perinatal bereavement support in Hong Kong: a pilot study. J Clin Nurs. 2003; 12(4):536–543. https://doi.org/10.1046/j.1365-2702.2003.00746.x.

10. Verdon C, deMontigny F. Experiences of nurses who support parents during perinatal death. J Obstet Gynecol Neonatal Nurs. 2021; 50(5):561–567. https://doi.org/10.1016/j.jogn.2021.04.008.

11. Khader Y, Alyahya M, Batieha A. Barriers to implementation of perinatal death audit in maternity and pediatric hospitals in Jordan: cross-sectional study. JMIR Public Health Surveill. 2019; 5(1):e11653. https://doi.org/10.2196/11653.

12. Wool C, Catlin A. Perinatal bereavement and palliative care offered throughout the healthcare system. Ann Palliat Med. 2019; 8(Suppl 1):S22–S29. https://doi.org/10.21037/apm.2018.11.03.

13. Almeida Fde A, Moraes MS, Cunha ML. Taking care of the newborn dying and their families: nurses’ experiences of neonatal intensive care. Rev Esc Enferm USP. 2016; 50(Spec):122–129. https://doi.org/10.1590/S0080-623420160000300018.

14. Ben-Ezra M, Palgi Y, Walker R, Many A, Hamam-Raz Y. The impact of perinatal death on obstetrics nurses: a longitudinal and cross-sectional examination. J Perinat Med. 2014; 42(1):75–81. https://doi.org/10.1515/jpm-2013-0071.

15. Park JY, Oh J. Influence of perceptions of death, end-of-life care stress, and emotional intelligence on attitudes towards end-of-life care among nurses in the neonatal intensive care unit. Child Health Nurs Res. 2019; 25(1):38–47. https://doi.org/10.4094/chnr.2019.25.1.38.

16. Köktürk Dalcalı B, Can Ş, Durgun H. Emotional responses of neonatal intensive care nurses to neonatal death. Omega (Westport). 2022; 85(2):497–513. https://doi.org/10.1177/0030222820971880.

17. Wallbank S, Robertson N. Predictors of staff distress in response to professionally experienced miscarriage, stillbirth and neonatal loss: a questionnaire survey. Int J Nurs Stud. 2013; 50(8):1090–1097. https://doi.org/10.1016/j.ijnurstu.2012.11.022.

18. Chan MF, Chan SH, Day MC. A pilot study on nurses’ attitudes toward perinatal bereavement support: a cluster analysi. Nurse Educ Today. 2004; 24(3):202–210. https://doi.org/10.1016/j.nedt.2003.11.009.

19. Hamama-Raz Y, Walker R, Palgi Y, Mashiach R, Lee-Ovadia K, Manny A, et al. Comorbidity of post-traumatic stress symptoms and depressive symptoms among obstetric nurses with perinatal death exposure. Isr J Psychiatry Relat Sci. 2016; 53(2):58–62. https://pubmed.ncbi.nlm.nih.gov/28079038/.

20. McCool W, Guidera M, Stenson M, Dauphinee L. The pain that binds us: midwives’ experiences of loss and adverse outcomes around the world. Health Care Women Int. 2009; 30(11):1003–1013. https://doi.org/10.1080/07399330903134455.

21. World Health Organization. Process of translation and adaptation of instruments [Internet]. Geneva: Author;2020. [cited 2020 Jul 16]. Available from: https://view.officeapps.live.com/op/view.aspx?src=https%3A%2F%2Fwww.mhinnovation.net%2Fsites%2Fdefault%2Ffiles%2Ffiles%2FWHO%2520Guidelines%2520on%2520Translation%2520and%2520Adaptation%2520of%2520Instruments.docx&wdOrigin=BROWSELINK.

22. Jang SH. Neonatal intensive care unit nurses’ stress of end-of-life care for high-risk newborn [master’s thesis]. Seoul: Ewha Womans University;2013. 59.

23. Furtado-Eraso S, Escalada-Hernández P, Marín-Fernández B. Integrative review of emotional care following perinatal loss. West J Nurs Res. 2021; 43(5):489–504. https://doi.org/10.1177/0193945920954448.

24. Jang HY, Chung CW. Delivery room nurses’ experiences of caring for stillborn babies and their parents. Korean J Women Health Nurs. 2017; 23(3):166–180. https://doi.org/10.4069/kjwhn.2017.23.3.166.

25. Kingdon C, Givens JL, O'Donnell E, Turner M. Seeing and holding baby: systematic review of clinical management and parental outcomes after stillbirth. Birth. 2015; 42(3):206–218. https://doi.org/10.1111/birt.12176.

26. Chan MF, Lou FL, Arthur DG. A survey comparing the attitudes toward perinatal bereavement care of nurses from three Asian cities. Eval Health Prof. 2010; 33(4):514–533. https://doi.org/10.1177/0163278710381092.

27. Kwon EH, Ju HO, Jeung EO, Han CH, Im JJ, Lee YR, et al. Stress due to end-of-life care, coping strategies, and psychological well-being among nurses in neonatal intensive care units. Child Health Nurs Res. 2018; 24(4):475–483. https://doi.org/10.4094/chnr.2018.24.4.475.

28. Choi J, Gu M, Oh S, Sok S. Relationship between end-of-life care stress, death anxiety, and self-efficacy of clinical nurses in South Korea. Int J Environ Res Public Health. 2022; 19(3):1082. https://doi.org/10.3390/ijerph19031082.

29. Kim KS. The relationship among perception of death, end-of-life care stress and end-of-life care attitude of nurses [master’s thesis]. Busan: Kosin University;2016. 61.

30. Kim GH. The perceptions of hospice palliative care and terminal care attitude of nurses at long-term care hospitals [master’s thesis]. Busan: Catholic University of Pusan;2016. 55.

31. Kim S, No MJ, Moon KE, Cho HJ, Park Y, Lee NJ, et al. Intensive care unit nurses’ death perception, end of life stress and end of life nursing attitudes. J Korean Clin Nurs Res. 2018; 24(2):255–262. https://doi.org/10.22650/JKCNR.2018.24.2.255.

32. Wi DH, Kang SJ. Relationship among nurses’ knowledge, attitude towards palliative care and perception of death in neonatal intensive care units. Child Health Nurs Res. 2016; 22(4):257–264. https://doi.org/10.4094/chnr.2016.22.4.257.